Healthcare Provider Details

I. General information

NPI: 1659754208
Provider Name (Legal Business Name): PRICE CHOPPER OPERATING CO OF MASS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2015
Last Update Date: 06/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 GALAXY PASS
SUTTON MA
01590-4836
US

IV. Provider business mailing address

461 NOTT ST MB #202
SCHENECTADY NY
12308-1812
US

V. Phone/Fax

Practice location:
  • Phone: 508-865-2513
  • Fax: 508-865-5240
Mailing address:
  • Phone: 518-379-1618
  • Fax: 518-356-6978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberDS89978
License Number StateMA

VIII. Authorized Official

Name: KATHLEEN BRYNAT
Title or Position: VP OF PHARMACY
Credential:
Phone: 518-379-1618